Schizotypal, schizoid and paranoid characteristics in the biological parents of social anhedonics.

Mounting evidence suggests that social anhedonia may be a marker of genetic liability for schizophrenia-spectrum pathology. To examine this hypothesis, we conducted a study of severity of schizotypal, schizoid and paranoid pathology (i.e., Cluster A personality disorders) in the biological parents of individuals with high levels of social anhedonia and healthy controls. Eighty-six individuals with social anhedonia, 89 healthy controls and their biological parents were recruited from a large community. Structured clinical interviews were conducted to obtain Cluster A diagnoses and symptom ratings for parents. The biological parents of socially anhedonic probands had elevated rates of Cluster A disorders (24%) compared with the parents of control probands (12%). Post hoc analyses revealed that these group differences were the result of elevated rates of diagnoses in the fathers of social anhedonic probands, but not the mothers. This finding was replicated when Cluster A symptoms were examined dimensionally. These findings are consistent with the hypothesis that social anhedonia is a promising indicator of the genetic vulnerability to schizophrenia-spectrum pathology. The unexpected findings of elevated pathology in fathers, but not mothers of socially anhedonic probands, require further exploration.

The Three Cities Test: preliminary validation of a short bedside memory test in persons with acute stroke.

Screening tests for memory can be administered more quickly than standard tests of memory. They can be particularly useful with patients with acute medical illness or with the elderly who are unable to tolerate complex or lengthy memory testing, such as patients with acute stroke. However, screening measures for memory often lack validation and may have significant psychometric limitations. The purpose of this study was to validate and determine the psychometric properties of the Three Cities Test (TCT), a short test of memory that uses a selective reminding paradigm and the names of well-known cities as stimuli. The TCT was administered to 115 subjects: 60 patients with acute cerebrovascular accidents (Stroke group) and 55 age-matched orthopedic control patients (Ortho group). Results show that the TCT was significantly correlated with general measures of cognition (MMSE), another well-validated measure of learning and memory (HVLT-R), and clinical variables such as length of hospitalization and functional recovery. Compared to the Ortho group, the Stroke group had significantly worse performance on the TCT in terms of number of trials to criterion, delayed recall, and recognition discrimination. Preliminary results suggest that this instrument is well-received by patients with acute medical illness and cognitive impairment and that it possesses good construct and discriminative validity. Sensitivity and specificity performance as well as recommended cut scores are offered for the TCT.

Behavioral signs of schizoidia and schizotypy in the biological parents of social anhedonics.

A community sample of 88 putative schizotypes (48 social anhedonics, 40 controls), aged 18 to 19 years, and their biological parents (42 mothers of social anhedonics, 37 mothers of controls; 24 fathers of social anhedonics, 20 fathers of controls) receive videotaped diagnostic evaluations that serve as the basis for ratings of behavioral signs of schizoidia and schizotypy. Proband social anhedonics exhibit more atypical interpersonal behaviors characteristic of schizoid and schizotypal personality disorders than controls. Mothers of social anhedonics display more atypical interpersonal behaviors characteristic of schizotypal personality disorder than mothers of controls. In contrast, clinical symptom ratings of schizotypy do not differentiate mothers of social anhedonics from mothers of controls. Meaningful, though not statistically significant, effects are observed for behavioral sign ratings in the smaller sample of fathers of social anhedonics. Results provide preliminary support for the familiality of atypical interpersonal behavior in social anhedonics.

Prevalence and longitudinal stability of negative symptoms in healthy participants.

OBJECTIVE: Although negative symptoms are prominent in older patients with schizophrenia, it is unknown whether this pattern is prevalent in healthy participants. The objective of this study was to evaluate whether negative symptoms are present in healthy populations and to determine whether they are linked to illness-related processes or normal aging. METHODS: A systemic review of 26 studies that have administered negative symptom assessments to healthy participants was conducted. In addition, 213 (age > 40 years old) healthy participants completed PANSS and SANS ratings at both baseline and 1-year follow-up. One-hundred participants also completed ratings after 3 years. RESULTS: Across all reviewed studies, negative symptoms were absent in the majority of participants. Comparable results were found in the current study's large longitudinal evaluation with middle-aged to older adults. CONCLUSIONS: Taken together, the data suggest that healthy volunteers do not suffer from prominent negative symptoms. This finding is consistent with the hypothesis that the greater prevalence and severity of negative symptoms in older patients is not related to normal aging but to illness-related processes.

Insight and treatment outcome with cognitive-behavioral social skills training for older people with schizophrenia.

Poor insight (awareness of having a mental illness that requires treatment) is common in schizophrenia and typically predicts poor outcome, yet greater insight has been linked to negative outcomes, including hopelessness. This study focused on two questions: (1) Does insight moderate the effects of cognitive-behavioral social skills training (CBSST) on functional outcomes in schizophrenia? (2) Does a specific type of insight (e.g., awareness of illness, need for treatment) predict benefit from CBSST? We examined insight as a predictor of everyday functioning in a randomized controlled trial of CBSST versus treatment as usual (TAU) for middle-aged and older people with schizophrenia (n = 62). We used linear regression models to examine moderators of the relationship between baseline insight and everyday functioning measured 12 months following completion of the 6-month intervention. Insight, especially insight into the need for treatment, moderated the relationship between treatment group and everyday functioning (Independent Living Skills Survey), such that CBSST offset the negative effect of insight on functioning observed with TAU (wherein greater insight was related to poorer everyday functioning). Post hoc analyses showed that reduction of insight-linked hopelessness may have accounted for the positive effect of CBSST on functioning relative to TAU.